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Ten tips to prepare for a surge in pediatric patients


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Forge relationships with local groups to make sure your hospital is ready

Research showing how well hospitals nationwide are equipped to handle disasters affecting children, such as a school building accident, bus crash, or other unthinkable event, doesn’t yet exist.

But if your area is anything like Los Angeles (LA) County, pediatric patients aren’t well represented in disaster plans. Childrens Hospital Los Angeles’ Pediatric Disaster Resource and Training Center reports that fewer than 25% of the 300-plus hospitals and trauma centers in LA County have disaster plans that specifically address the needs of children.

Yet children pose challenges that are different from adults, says Jeffrey Upperman, MD, the center’s program director. For example, what happens when responders deposit at the hospital a group of children separated from their parents?

“You have to sort out what to do with those children. You can’t just give a three-year-old a food voucher and say, ‘Good luck, kid, see you later,’ ” says Upperman. His group receives federal funds to coordinate the supply chain for all of LA County in the event of a disaster involving children. Another part of its mission is to provide educational materials to hospitals.

Questions about ED ability

Hospital disaster preparedness for this potential victim population is lacking across the board, say Upperman and Gary Peck, MD, FAAP, chair of the American Academy of Pediatrics’ (AAP) Disaster Preparedness Advisory Council.

Peck says he believes that hospitals in general aren’t adequately prepared even to administer care to pediatric patients on a daily basis. He notes the Institute of Medicine’s 2006 report, Emergency Care for Children: Growing Pains, which stated only 6% of the nation’s EDs are fully supplied to care for children. This is probably because children typically represent only a small percentage of ED patients.

“If you’re not prepared for general pediatric care, how can you be prepared for a disaster?” Peck says. “All of a sudden, there’s a disaster at an elementary school and you have 100% children. If you can’t take care of 10 [pediatric patients] a month, how are you going to take care of the whole school?”

Ways to prepare for young victims

Peck and Upperman offer the following 10 tips to prepare you for a pediatric surge, which go deeper than simply lining up more neonatal ICU ventilators:

Stake out your territory. Determine the number of schools in the area your hospital services and how many students populate them. Build these figures into your hazard vulnerability analysis, and reach out to the schools to understand their needs.

Lean on your workers. Interview staff members who have children about what their needs might be in a disaster—specific to your area—and factor that information into your plan.

For example, if your area is prone to flooding, ask employees what their kids’ needs would be in the event of a flood and what it would take to make sure that workers could come to work.

The answer might be that your facility needs to line up childcare, and the schools you contacted may have some ideas on how to handle that.

Conduct realistic drills. Use actual children if you can secure parental permission. Peck and Upperman say many hospitals designate inanimate props as children, which isn’t viable. One hospital recently represented children in a disaster drill with 5-gal. water jugs in the yard with a list of symptoms taped to them, Peck says.

Using such props leaves responders far less ready in the event of a real disaster. Upperman’s group employs scout troops as disaster victims for multihospital drills it periodically leads.

Search the Web for information. Glean detailed reports and best practices from organizations such as the AAP, Institute of Medicine, and U.S. Agency for Healthcare Research and Quality, which constantly updates its content about pediatric disasters (see “A starting point” below for more information).

Talk to your pediatricians. You have access to in-house experts: your hospital’s pediatricians. If they seem too busy, remind them that the AAP, their national professional organization, urges all pediatricians to stay involved with disaster planning activities, such as drills, on local, regional, state, and federal levels.

Prepare for behavioral needs. Counseling and mental health issues for children are different than for adults, and the resources to handle them are few, Peck says. Children are less communicative, and their posttraumatic stress symptoms are more difficult to recognize and treat. Local child-advocacy groups can help in this regard by offering advice about your planning efforts.

Make plans for parent reunification. Upperman says that in several disasters his group has researched, police and fire responders who found children separated from their parents weren’t always sure how to handle the situation. In many cases, the responders dropped off the kids at a hospital.

So, designate a place to keep children who have been separated from their parents in a disaster, and write a protocol for reuniting them with their parents.

Customize your plan according to health data. Upperman’s group is working with the U.S. Department of Health and Human Services to develop decisionsupport software to help responders understand the potential health issues of pediatric patients in a given community. On a smaller level, you can get started by looking at public health statistics for your area. For example, if 60% of the children in your community have asthma and another 20% have diabetes, your disaster plan should be ready for patients with one or both conditions.

Think about decontamination exercises. Not all adult gear works with children or can be adapted. Consider creating a drill in which a school gets exposed to a chemical contaminant and the victims all need to enter a decontamination shower. It’s unlikely you’ll be able to send kids through a decon tent as part of a drill—imagine parent reactions—but you could gauge how well your decon supply stockpile stacks up to the scenario.

Connect with child-specific community resources. There are federally managed caches of equipment, government agencies, children’s hospitals, trade associations, local Red Cross chapters, school health experts, and other private institutions in your area that know kids’ special needs. Network your way into these groups to learn the lay of the land in regard to pediatric resources available in your area and establish communication with these groups. If you work in an adult-centered hospital, coordinate agreements for the transfer of pediatric patients to children’s facilities.

The Pediatric Disaster Resource and Training Center shares information on its Web site (www.chladisastercenter.org), including research and best practices for pediatric disaster response, says Upperman. The center invites hospital preparedness authorities to visit the Web site regularly, keep current with new content, and take what they can use for their own plans.

A starting point

Plan for pediatric surges with “The Pediatrician and Disaster Preparedness,” a free report published by the American Academy of Pediatrics. This report is loaded with advice, contacts, and references centering on how to prepare for disasters involving pediatric patients.

Go to http://pediatrics.aappublications.org and type “disaster” in the search bar.